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House subcommittee OKs sunscreen ingredient proposal
The Health subcommittee of the House Energy & Commerce Committee unanimously advanced a proposal to make it easier for manufacturers to get new sunscreen ingredients approved by the Food and Drug Administration.
The subcommittee approved the legislation, the Sunscreen Innovation Act (H.R. 4250) on June 19. It has now been referred to the full Energy & Commerce Committee for approval.
One of the bill’s cosponsors, Rep. Ed Whitfield (R-Ky.) said that too many potentially innovative ingredients were languishing at the FDA, including at least one that had been there for a decade. "The American public is being denied effective sunscreen products that have been used safely overseas for years," said Rep. Whitfield, at a mark-up of the legislation.
He said that two outside advocacy groups – the Public Access To SunScreens (PASS) Coalition, a partnership of health organizations, sunscreen ingredient companies, and citizens, and the Environmental Working Group – had been instrumental in crafting the legislation and making sure there was an agreement that would satisfy manufacturers and also protect the public’s health.
Energy & Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement submitted for the record that "it is unacceptable that the FDA has not approved a new sunscreen ingredient in nearly 2 decades." He said this was especially a problem given that there is now "a much better understanding of the deadly consequences of excessive sun exposure."
The Sunscreen Innovation Act would overhaul the reviews and approval process, said Rep. Upton.
Members of the committee are still hashing out some issues on the legislation, including timeframes for FDA review of pending and new applications. Rep. Henry Waxman (D-Calif.) said that the review process had led to "unacceptable backlogs" and unnecessary delays, but, he added, "I will not support a bill that sets FDA up for failure by imposing unrealistic timeframes for action."
The full Energy & Commerce Committee has not yet scheduled a date for taking up the bill.
On Twitter @aliciaault
The Health subcommittee of the House Energy & Commerce Committee unanimously advanced a proposal to make it easier for manufacturers to get new sunscreen ingredients approved by the Food and Drug Administration.
The subcommittee approved the legislation, the Sunscreen Innovation Act (H.R. 4250) on June 19. It has now been referred to the full Energy & Commerce Committee for approval.
One of the bill’s cosponsors, Rep. Ed Whitfield (R-Ky.) said that too many potentially innovative ingredients were languishing at the FDA, including at least one that had been there for a decade. "The American public is being denied effective sunscreen products that have been used safely overseas for years," said Rep. Whitfield, at a mark-up of the legislation.
He said that two outside advocacy groups – the Public Access To SunScreens (PASS) Coalition, a partnership of health organizations, sunscreen ingredient companies, and citizens, and the Environmental Working Group – had been instrumental in crafting the legislation and making sure there was an agreement that would satisfy manufacturers and also protect the public’s health.
Energy & Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement submitted for the record that "it is unacceptable that the FDA has not approved a new sunscreen ingredient in nearly 2 decades." He said this was especially a problem given that there is now "a much better understanding of the deadly consequences of excessive sun exposure."
The Sunscreen Innovation Act would overhaul the reviews and approval process, said Rep. Upton.
Members of the committee are still hashing out some issues on the legislation, including timeframes for FDA review of pending and new applications. Rep. Henry Waxman (D-Calif.) said that the review process had led to "unacceptable backlogs" and unnecessary delays, but, he added, "I will not support a bill that sets FDA up for failure by imposing unrealistic timeframes for action."
The full Energy & Commerce Committee has not yet scheduled a date for taking up the bill.
On Twitter @aliciaault
The Health subcommittee of the House Energy & Commerce Committee unanimously advanced a proposal to make it easier for manufacturers to get new sunscreen ingredients approved by the Food and Drug Administration.
The subcommittee approved the legislation, the Sunscreen Innovation Act (H.R. 4250) on June 19. It has now been referred to the full Energy & Commerce Committee for approval.
One of the bill’s cosponsors, Rep. Ed Whitfield (R-Ky.) said that too many potentially innovative ingredients were languishing at the FDA, including at least one that had been there for a decade. "The American public is being denied effective sunscreen products that have been used safely overseas for years," said Rep. Whitfield, at a mark-up of the legislation.
He said that two outside advocacy groups – the Public Access To SunScreens (PASS) Coalition, a partnership of health organizations, sunscreen ingredient companies, and citizens, and the Environmental Working Group – had been instrumental in crafting the legislation and making sure there was an agreement that would satisfy manufacturers and also protect the public’s health.
Energy & Commerce Committee Chairman Fred Upton (R-Mich.) said in a statement submitted for the record that "it is unacceptable that the FDA has not approved a new sunscreen ingredient in nearly 2 decades." He said this was especially a problem given that there is now "a much better understanding of the deadly consequences of excessive sun exposure."
The Sunscreen Innovation Act would overhaul the reviews and approval process, said Rep. Upton.
Members of the committee are still hashing out some issues on the legislation, including timeframes for FDA review of pending and new applications. Rep. Henry Waxman (D-Calif.) said that the review process had led to "unacceptable backlogs" and unnecessary delays, but, he added, "I will not support a bill that sets FDA up for failure by imposing unrealistic timeframes for action."
The full Energy & Commerce Committee has not yet scheduled a date for taking up the bill.
On Twitter @aliciaault
AMA defers action on Medicaid pay parity
CHICAGO – The American Medical Association House of Delegates voted to defer taking action on Medicaid payment policy so that the primary care societies can continue an almost-year-long lobbying effort to convince Congress to extend a Medicaid pay increase.
The pay increase, established under the Affordable Care Act, brings Medicaid pay up to the same level as Medicare reimbursement for eligible primary care physicians. Currently, family physicians, general internists, pediatricians, and subspecialists in those categories are eligible for the pay increase if they are board certified or can show that at least 60% of the codes they submitted to Medicaid in 2012 were for primary care services. The increase expires on Dec. 31.
At least a year ago, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Osteopathic Association struck an agreement to urge Congress to extend the pay increase for at least 2 years, and to add ob.gyns. to the list of eligible specialists, Dr. Reid Blackwelder, president of the AAFP, said at the House of Delegates meeting.
He offered a resolution to the House to include ob.gyns. as eligible, but the amendment led to some confusion.
The AMA Council on Medical Service was already recommending that the AMA advocate for both an extension of the payments and to add ob.gyns. to the eligibility list, as AMA policy recognizes them as a primary care specialty.
Initially, an amendment had been offered suggesting that ob.gyns. would have to meet different requirements to get the increased pay. That upset some delegates. But Dr. Blackwelder said that his amendment would "use the same accepted threshold methodology" as for internists, pediatricians, and family physicians.
Even so, many delegates said they were not in favor of the resolution. Dr. Lisa Egbert, an ob.gyn. on the Council on Medical Service, said that for one, current legislation did not give her specialty an opportunity to receive the pay increase. The Council report gave clear directions on how the AMA could lobby Congress to change that, she said.
As debate began again the next day, delegates from the AAFP and the ACP retreated from their amendment, and instead asked that it, along with any AMA action on the pay parity issue, be deferred. They noted the ongoing joint effort by the AAFP, ACP, AAP, and ACOG to help persuade Congress that pay parity needed to be extended.
The four societies sent a letter to Senate Finance Committee leaders Ron Wyden (D-Ore.) and Orrin Hatch (R-Utah) and House Energy & Commerce Committee leaders Fred Upton (R-Mich.) and Henry Waxman (D-Calif.) on May 21, seeking the 2-year extension and also to add ob.gyns.
On June 10, it was resent to the same legislators with 16 additional signatories including other osteopathic organizations, the Society of Hospital Medicine, and the Children’s Hospital Association.
Dr. Yul Ejnes, an ACP delegate and a previous ACP board chairman, urged the AMA delegates to defer action. Otherwise, "it would be injurious to [our] effort, as well as to our AMA, if this body came out with different policy that contradicted what the four organizations are trying to do," said Dr. Ejnes.
AAFP Board Chair Jeffrey Cain agreed. "It would be injurious to the AMA’s reputation to come out against the four groups representing primary care on Capitol Hill," he said.
The delegates voted 223-174 to put off action, referring the amendments and the Council’s report for study by the AMA’s Board of Trustees.
On Twitter @aliciaault
CHICAGO – The American Medical Association House of Delegates voted to defer taking action on Medicaid payment policy so that the primary care societies can continue an almost-year-long lobbying effort to convince Congress to extend a Medicaid pay increase.
The pay increase, established under the Affordable Care Act, brings Medicaid pay up to the same level as Medicare reimbursement for eligible primary care physicians. Currently, family physicians, general internists, pediatricians, and subspecialists in those categories are eligible for the pay increase if they are board certified or can show that at least 60% of the codes they submitted to Medicaid in 2012 were for primary care services. The increase expires on Dec. 31.
At least a year ago, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Osteopathic Association struck an agreement to urge Congress to extend the pay increase for at least 2 years, and to add ob.gyns. to the list of eligible specialists, Dr. Reid Blackwelder, president of the AAFP, said at the House of Delegates meeting.
He offered a resolution to the House to include ob.gyns. as eligible, but the amendment led to some confusion.
The AMA Council on Medical Service was already recommending that the AMA advocate for both an extension of the payments and to add ob.gyns. to the eligibility list, as AMA policy recognizes them as a primary care specialty.
Initially, an amendment had been offered suggesting that ob.gyns. would have to meet different requirements to get the increased pay. That upset some delegates. But Dr. Blackwelder said that his amendment would "use the same accepted threshold methodology" as for internists, pediatricians, and family physicians.
Even so, many delegates said they were not in favor of the resolution. Dr. Lisa Egbert, an ob.gyn. on the Council on Medical Service, said that for one, current legislation did not give her specialty an opportunity to receive the pay increase. The Council report gave clear directions on how the AMA could lobby Congress to change that, she said.
As debate began again the next day, delegates from the AAFP and the ACP retreated from their amendment, and instead asked that it, along with any AMA action on the pay parity issue, be deferred. They noted the ongoing joint effort by the AAFP, ACP, AAP, and ACOG to help persuade Congress that pay parity needed to be extended.
The four societies sent a letter to Senate Finance Committee leaders Ron Wyden (D-Ore.) and Orrin Hatch (R-Utah) and House Energy & Commerce Committee leaders Fred Upton (R-Mich.) and Henry Waxman (D-Calif.) on May 21, seeking the 2-year extension and also to add ob.gyns.
On June 10, it was resent to the same legislators with 16 additional signatories including other osteopathic organizations, the Society of Hospital Medicine, and the Children’s Hospital Association.
Dr. Yul Ejnes, an ACP delegate and a previous ACP board chairman, urged the AMA delegates to defer action. Otherwise, "it would be injurious to [our] effort, as well as to our AMA, if this body came out with different policy that contradicted what the four organizations are trying to do," said Dr. Ejnes.
AAFP Board Chair Jeffrey Cain agreed. "It would be injurious to the AMA’s reputation to come out against the four groups representing primary care on Capitol Hill," he said.
The delegates voted 223-174 to put off action, referring the amendments and the Council’s report for study by the AMA’s Board of Trustees.
On Twitter @aliciaault
CHICAGO – The American Medical Association House of Delegates voted to defer taking action on Medicaid payment policy so that the primary care societies can continue an almost-year-long lobbying effort to convince Congress to extend a Medicaid pay increase.
The pay increase, established under the Affordable Care Act, brings Medicaid pay up to the same level as Medicare reimbursement for eligible primary care physicians. Currently, family physicians, general internists, pediatricians, and subspecialists in those categories are eligible for the pay increase if they are board certified or can show that at least 60% of the codes they submitted to Medicaid in 2012 were for primary care services. The increase expires on Dec. 31.
At least a year ago, the American Academy of Family Physicians, the American College of Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Osteopathic Association struck an agreement to urge Congress to extend the pay increase for at least 2 years, and to add ob.gyns. to the list of eligible specialists, Dr. Reid Blackwelder, president of the AAFP, said at the House of Delegates meeting.
He offered a resolution to the House to include ob.gyns. as eligible, but the amendment led to some confusion.
The AMA Council on Medical Service was already recommending that the AMA advocate for both an extension of the payments and to add ob.gyns. to the eligibility list, as AMA policy recognizes them as a primary care specialty.
Initially, an amendment had been offered suggesting that ob.gyns. would have to meet different requirements to get the increased pay. That upset some delegates. But Dr. Blackwelder said that his amendment would "use the same accepted threshold methodology" as for internists, pediatricians, and family physicians.
Even so, many delegates said they were not in favor of the resolution. Dr. Lisa Egbert, an ob.gyn. on the Council on Medical Service, said that for one, current legislation did not give her specialty an opportunity to receive the pay increase. The Council report gave clear directions on how the AMA could lobby Congress to change that, she said.
As debate began again the next day, delegates from the AAFP and the ACP retreated from their amendment, and instead asked that it, along with any AMA action on the pay parity issue, be deferred. They noted the ongoing joint effort by the AAFP, ACP, AAP, and ACOG to help persuade Congress that pay parity needed to be extended.
The four societies sent a letter to Senate Finance Committee leaders Ron Wyden (D-Ore.) and Orrin Hatch (R-Utah) and House Energy & Commerce Committee leaders Fred Upton (R-Mich.) and Henry Waxman (D-Calif.) on May 21, seeking the 2-year extension and also to add ob.gyns.
On June 10, it was resent to the same legislators with 16 additional signatories including other osteopathic organizations, the Society of Hospital Medicine, and the Children’s Hospital Association.
Dr. Yul Ejnes, an ACP delegate and a previous ACP board chairman, urged the AMA delegates to defer action. Otherwise, "it would be injurious to [our] effort, as well as to our AMA, if this body came out with different policy that contradicted what the four organizations are trying to do," said Dr. Ejnes.
AAFP Board Chair Jeffrey Cain agreed. "It would be injurious to the AMA’s reputation to come out against the four groups representing primary care on Capitol Hill," he said.
The delegates voted 223-174 to put off action, referring the amendments and the Council’s report for study by the AMA’s Board of Trustees.
On Twitter @aliciaault
AT THE AMA HOD MEETING
AAP launching initiative to address toxic stress
WASHINGTON – The American Academy of Pediatrics is starting a new initiative that aims to help physicians, researchers, educators, legislators, and parents address the impact of toxic stress on children.
The Center on Healthy, Resilient Children will collect and disseminate the latest scientific evidence on brain health and development and ways to prevent toxic stress. It will also help pediatricians and others identify children who have experienced adversity and then steer them to appropriate supports.
Toxic stress is defined as strong, frequent, and/or prolonged adversity such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and the accumulated burden of economic hardship, according to the Harvard University Center on the Developing Child.
Children in those situations who do not have adequate adult support can develop a prolonged activation of the stress response system, which can disrupt the brain’s development and increase the risk for stress-related disease and cognitive impairment, even into adulthood.
In 2012, the AAP outlined a call to action on toxic stress (Pediatrics 2012;129:e224-e231). The Center is a way to disseminate the policy and translate it into practice, said Dr. V. Fan Tait, AAP associate executive director, and director of its department of Child Health and Wellness. It will coordinate the work of all the AAP sections and committees, and reach out to government agencies and private organizations to help find the gaps, develop tools to address poverty, link with scientists, and encourage, also, said Dr. Tait, a pediatric neurologist.
"There needs to be a change in the climate, in our own communities, in our states, and in the way our nation approaches the antecedents of health issues and the antecedents of child wellbeing issues, which are all intimately connected," said Dr. Robert Block, a past president of the AAP who will serve as the medical director of the new center.
Intervening early will help foster an overall healthier society, he said.
"All adults once were children. Who we are, who the adults are, are heavily influenced by what happens in childhood," said Dr. Block, a professor of pediatrics at the University of Oklahoma.
To address toxic stress, pediatricians can first examine ecology of a child’s environment – that is, ask about family life or screen children who might be at high risk of adversity, he said.
There is no perfect screen right now, said Dr. Andrew Garner, chair of the AAP Early Brain and Child Development Leadership Work Group. Instead of focusing on the child’s behavior or dysfunction, pediatricians can "look upstream," said Dr. Garner of the department of pediatrics at Case Western Reserve University, Cleveland, and lead author of the toxic stress paper in Pediatrics.
Even if there is no specific intervention to offer, "We can always demystify, we can always destigmatize, and we can always provide support," Dr. Garner said.
Clinicians also need tools to help teach children the skills to adapt to stress "in a healthy manner as opposed to a maladaptive manner," he said. The goal is not to "put kids in a bubble," but to "actively build resilience."
The resiliency center will also promote the patient-centered medical home as a model to help pediatricians link to other health providers or resources that can aid their patients and families, said Dr. James Perrin, AAP president.
It is clear that the fee-for-service model won’t be the ideal for comprehensively addressing toxic stress, said Dr. Perrin.
Seeking payment for the additional effort may be in the cards, Dr. Tait added.
The center can help give pediatricians what they need to disrupt the handing down of behavioral and health care woes from generation to generation, said Dr. Perrin. "It’s an epic journey, it’s a critically important journey for all of us, and it begins today," he said.
On Twitter @aliciaault
WASHINGTON – The American Academy of Pediatrics is starting a new initiative that aims to help physicians, researchers, educators, legislators, and parents address the impact of toxic stress on children.
The Center on Healthy, Resilient Children will collect and disseminate the latest scientific evidence on brain health and development and ways to prevent toxic stress. It will also help pediatricians and others identify children who have experienced adversity and then steer them to appropriate supports.
Toxic stress is defined as strong, frequent, and/or prolonged adversity such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and the accumulated burden of economic hardship, according to the Harvard University Center on the Developing Child.
Children in those situations who do not have adequate adult support can develop a prolonged activation of the stress response system, which can disrupt the brain’s development and increase the risk for stress-related disease and cognitive impairment, even into adulthood.
In 2012, the AAP outlined a call to action on toxic stress (Pediatrics 2012;129:e224-e231). The Center is a way to disseminate the policy and translate it into practice, said Dr. V. Fan Tait, AAP associate executive director, and director of its department of Child Health and Wellness. It will coordinate the work of all the AAP sections and committees, and reach out to government agencies and private organizations to help find the gaps, develop tools to address poverty, link with scientists, and encourage, also, said Dr. Tait, a pediatric neurologist.
"There needs to be a change in the climate, in our own communities, in our states, and in the way our nation approaches the antecedents of health issues and the antecedents of child wellbeing issues, which are all intimately connected," said Dr. Robert Block, a past president of the AAP who will serve as the medical director of the new center.
Intervening early will help foster an overall healthier society, he said.
"All adults once were children. Who we are, who the adults are, are heavily influenced by what happens in childhood," said Dr. Block, a professor of pediatrics at the University of Oklahoma.
To address toxic stress, pediatricians can first examine ecology of a child’s environment – that is, ask about family life or screen children who might be at high risk of adversity, he said.
There is no perfect screen right now, said Dr. Andrew Garner, chair of the AAP Early Brain and Child Development Leadership Work Group. Instead of focusing on the child’s behavior or dysfunction, pediatricians can "look upstream," said Dr. Garner of the department of pediatrics at Case Western Reserve University, Cleveland, and lead author of the toxic stress paper in Pediatrics.
Even if there is no specific intervention to offer, "We can always demystify, we can always destigmatize, and we can always provide support," Dr. Garner said.
Clinicians also need tools to help teach children the skills to adapt to stress "in a healthy manner as opposed to a maladaptive manner," he said. The goal is not to "put kids in a bubble," but to "actively build resilience."
The resiliency center will also promote the patient-centered medical home as a model to help pediatricians link to other health providers or resources that can aid their patients and families, said Dr. James Perrin, AAP president.
It is clear that the fee-for-service model won’t be the ideal for comprehensively addressing toxic stress, said Dr. Perrin.
Seeking payment for the additional effort may be in the cards, Dr. Tait added.
The center can help give pediatricians what they need to disrupt the handing down of behavioral and health care woes from generation to generation, said Dr. Perrin. "It’s an epic journey, it’s a critically important journey for all of us, and it begins today," he said.
On Twitter @aliciaault
WASHINGTON – The American Academy of Pediatrics is starting a new initiative that aims to help physicians, researchers, educators, legislators, and parents address the impact of toxic stress on children.
The Center on Healthy, Resilient Children will collect and disseminate the latest scientific evidence on brain health and development and ways to prevent toxic stress. It will also help pediatricians and others identify children who have experienced adversity and then steer them to appropriate supports.
Toxic stress is defined as strong, frequent, and/or prolonged adversity such as physical or emotional abuse, chronic neglect, caregiver substance abuse or mental illness, exposure to violence, and the accumulated burden of economic hardship, according to the Harvard University Center on the Developing Child.
Children in those situations who do not have adequate adult support can develop a prolonged activation of the stress response system, which can disrupt the brain’s development and increase the risk for stress-related disease and cognitive impairment, even into adulthood.
In 2012, the AAP outlined a call to action on toxic stress (Pediatrics 2012;129:e224-e231). The Center is a way to disseminate the policy and translate it into practice, said Dr. V. Fan Tait, AAP associate executive director, and director of its department of Child Health and Wellness. It will coordinate the work of all the AAP sections and committees, and reach out to government agencies and private organizations to help find the gaps, develop tools to address poverty, link with scientists, and encourage, also, said Dr. Tait, a pediatric neurologist.
"There needs to be a change in the climate, in our own communities, in our states, and in the way our nation approaches the antecedents of health issues and the antecedents of child wellbeing issues, which are all intimately connected," said Dr. Robert Block, a past president of the AAP who will serve as the medical director of the new center.
Intervening early will help foster an overall healthier society, he said.
"All adults once were children. Who we are, who the adults are, are heavily influenced by what happens in childhood," said Dr. Block, a professor of pediatrics at the University of Oklahoma.
To address toxic stress, pediatricians can first examine ecology of a child’s environment – that is, ask about family life or screen children who might be at high risk of adversity, he said.
There is no perfect screen right now, said Dr. Andrew Garner, chair of the AAP Early Brain and Child Development Leadership Work Group. Instead of focusing on the child’s behavior or dysfunction, pediatricians can "look upstream," said Dr. Garner of the department of pediatrics at Case Western Reserve University, Cleveland, and lead author of the toxic stress paper in Pediatrics.
Even if there is no specific intervention to offer, "We can always demystify, we can always destigmatize, and we can always provide support," Dr. Garner said.
Clinicians also need tools to help teach children the skills to adapt to stress "in a healthy manner as opposed to a maladaptive manner," he said. The goal is not to "put kids in a bubble," but to "actively build resilience."
The resiliency center will also promote the patient-centered medical home as a model to help pediatricians link to other health providers or resources that can aid their patients and families, said Dr. James Perrin, AAP president.
It is clear that the fee-for-service model won’t be the ideal for comprehensively addressing toxic stress, said Dr. Perrin.
Seeking payment for the additional effort may be in the cards, Dr. Tait added.
The center can help give pediatricians what they need to disrupt the handing down of behavioral and health care woes from generation to generation, said Dr. Perrin. "It’s an epic journey, it’s a critically important journey for all of us, and it begins today," he said.
On Twitter @aliciaault
AT AN AAP SYMPOSIUM
Impact of poor sleep on GPA equal to binge drinking for college students
MINNEAPOLIS – College students who do not get enough sleep experience an impact on their academic performance that is on par with binge drinking or regular marijuana use, two researchers say.
"The cultural assumption is that college is a time of bad sleep, and that all-nighters fueled by energy drinks and cheap pizza are just an inherent part of what it means to be a student," investigators J. Roxanne Prichard, Ph.D., and Monica Hartmann, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
But they say that assumption is shortsighted and wrong. "Well-rested students perform better academically and are healthier physically and psychologically," the researchers said.
Dr. Prichard of the department of neuroscience at the University of St. Thomas, St. Paul, Minn., and Dr. Hartmann,professor of economics at the university analyzed data from the Spring 2009 NCHA (the American College Health Association National College Health Assessment), which included survey information from 72, 966 students, 63% of whom were female and 75% of whom were white.
Students who participated in the survey were asked about their physical and mental health, sexual activity, and substance use, among other issues. They also were asked whether they’ve had sleep problems or had been diagnosed with a sleep disorder or insomnia.
Using data from more than 43,000 respondents, the researchers attempted to evaluate factors that predicted academic problems, including dropping a course, earning a lower course grade, and having a lower cumulative grade point average. The researchers examined those impacts for all students but focused on freshmen, because first-year performance "has such a large effect on retention rates and thus the economic stability for the institution of higher education," the researchers said. They found that sleep timing and sleep-related problems in college students were a strong predictor of academic problems, even after they controlled for other factors that might have had an impact, including clinical depression, feeling isolated, and a diagnosis of a learning disability or chronic health issue.
Students who earned "A" grades reported experiencing fewer of the following sleep issues: early awakenings, feeling sleepy during the day, going to bed early because they could not stay awake, or having trouble falling asleep. Students with worse grades tended to report more sleep issues.
Sleep problems had about the same impact on GPA as did binge drinking and marijuana use, the authors reported. In freshmen, poor sleep was an independent predictor of whether a student would drop or withdraw from a course. The authors adjusted their analysis to account for race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
Reducing sleep problems might have had a greater impact than reducing binge drinking or marijuana use, they said. For instance, improving sleep on just 1 night a week reduced the probability that a freshman drops a course by about 15%, the authors found.
Dr. Prichard and Dr. Hartmann also tried to gauge the effect that sleep disturbances in college eventually might have on the university’s ability to keep the student and the student’s future earnings potential. They determined that a sleep screening program that identified students at risk and led to treatment would be cost effective, even for the smallest universities. "Identifying and treating students with undiagnosed sleep problems early on in a student’s career economically benefits the university through increased retention and increases the students’ lifetime earning potential," they said.
But they noted that most institutions of higher learning do not pay much attention to students’ sleep habits. Rarely is there any time or money devoted to improving sleep, and if there is, it’s much less than the amount spent to address learning disabilities, substance abuse, and contagious illness, the researchers said. They encouraged a reexamination of the resources directed toward sleep quality in this population.
Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
On Twitter @aliciaault
MINNEAPOLIS – College students who do not get enough sleep experience an impact on their academic performance that is on par with binge drinking or regular marijuana use, two researchers say.
"The cultural assumption is that college is a time of bad sleep, and that all-nighters fueled by energy drinks and cheap pizza are just an inherent part of what it means to be a student," investigators J. Roxanne Prichard, Ph.D., and Monica Hartmann, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
But they say that assumption is shortsighted and wrong. "Well-rested students perform better academically and are healthier physically and psychologically," the researchers said.
Dr. Prichard of the department of neuroscience at the University of St. Thomas, St. Paul, Minn., and Dr. Hartmann,professor of economics at the university analyzed data from the Spring 2009 NCHA (the American College Health Association National College Health Assessment), which included survey information from 72, 966 students, 63% of whom were female and 75% of whom were white.
Students who participated in the survey were asked about their physical and mental health, sexual activity, and substance use, among other issues. They also were asked whether they’ve had sleep problems or had been diagnosed with a sleep disorder or insomnia.
Using data from more than 43,000 respondents, the researchers attempted to evaluate factors that predicted academic problems, including dropping a course, earning a lower course grade, and having a lower cumulative grade point average. The researchers examined those impacts for all students but focused on freshmen, because first-year performance "has such a large effect on retention rates and thus the economic stability for the institution of higher education," the researchers said. They found that sleep timing and sleep-related problems in college students were a strong predictor of academic problems, even after they controlled for other factors that might have had an impact, including clinical depression, feeling isolated, and a diagnosis of a learning disability or chronic health issue.
Students who earned "A" grades reported experiencing fewer of the following sleep issues: early awakenings, feeling sleepy during the day, going to bed early because they could not stay awake, or having trouble falling asleep. Students with worse grades tended to report more sleep issues.
Sleep problems had about the same impact on GPA as did binge drinking and marijuana use, the authors reported. In freshmen, poor sleep was an independent predictor of whether a student would drop or withdraw from a course. The authors adjusted their analysis to account for race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
Reducing sleep problems might have had a greater impact than reducing binge drinking or marijuana use, they said. For instance, improving sleep on just 1 night a week reduced the probability that a freshman drops a course by about 15%, the authors found.
Dr. Prichard and Dr. Hartmann also tried to gauge the effect that sleep disturbances in college eventually might have on the university’s ability to keep the student and the student’s future earnings potential. They determined that a sleep screening program that identified students at risk and led to treatment would be cost effective, even for the smallest universities. "Identifying and treating students with undiagnosed sleep problems early on in a student’s career economically benefits the university through increased retention and increases the students’ lifetime earning potential," they said.
But they noted that most institutions of higher learning do not pay much attention to students’ sleep habits. Rarely is there any time or money devoted to improving sleep, and if there is, it’s much less than the amount spent to address learning disabilities, substance abuse, and contagious illness, the researchers said. They encouraged a reexamination of the resources directed toward sleep quality in this population.
Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
On Twitter @aliciaault
MINNEAPOLIS – College students who do not get enough sleep experience an impact on their academic performance that is on par with binge drinking or regular marijuana use, two researchers say.
"The cultural assumption is that college is a time of bad sleep, and that all-nighters fueled by energy drinks and cheap pizza are just an inherent part of what it means to be a student," investigators J. Roxanne Prichard, Ph.D., and Monica Hartmann, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
But they say that assumption is shortsighted and wrong. "Well-rested students perform better academically and are healthier physically and psychologically," the researchers said.
Dr. Prichard of the department of neuroscience at the University of St. Thomas, St. Paul, Minn., and Dr. Hartmann,professor of economics at the university analyzed data from the Spring 2009 NCHA (the American College Health Association National College Health Assessment), which included survey information from 72, 966 students, 63% of whom were female and 75% of whom were white.
Students who participated in the survey were asked about their physical and mental health, sexual activity, and substance use, among other issues. They also were asked whether they’ve had sleep problems or had been diagnosed with a sleep disorder or insomnia.
Using data from more than 43,000 respondents, the researchers attempted to evaluate factors that predicted academic problems, including dropping a course, earning a lower course grade, and having a lower cumulative grade point average. The researchers examined those impacts for all students but focused on freshmen, because first-year performance "has such a large effect on retention rates and thus the economic stability for the institution of higher education," the researchers said. They found that sleep timing and sleep-related problems in college students were a strong predictor of academic problems, even after they controlled for other factors that might have had an impact, including clinical depression, feeling isolated, and a diagnosis of a learning disability or chronic health issue.
Students who earned "A" grades reported experiencing fewer of the following sleep issues: early awakenings, feeling sleepy during the day, going to bed early because they could not stay awake, or having trouble falling asleep. Students with worse grades tended to report more sleep issues.
Sleep problems had about the same impact on GPA as did binge drinking and marijuana use, the authors reported. In freshmen, poor sleep was an independent predictor of whether a student would drop or withdraw from a course. The authors adjusted their analysis to account for race, gender, work hours, chronic illness, and psychiatric problems such as anxiety.
Reducing sleep problems might have had a greater impact than reducing binge drinking or marijuana use, they said. For instance, improving sleep on just 1 night a week reduced the probability that a freshman drops a course by about 15%, the authors found.
Dr. Prichard and Dr. Hartmann also tried to gauge the effect that sleep disturbances in college eventually might have on the university’s ability to keep the student and the student’s future earnings potential. They determined that a sleep screening program that identified students at risk and led to treatment would be cost effective, even for the smallest universities. "Identifying and treating students with undiagnosed sleep problems early on in a student’s career economically benefits the university through increased retention and increases the students’ lifetime earning potential," they said.
But they noted that most institutions of higher learning do not pay much attention to students’ sleep habits. Rarely is there any time or money devoted to improving sleep, and if there is, it’s much less than the amount spent to address learning disabilities, substance abuse, and contagious illness, the researchers said. They encouraged a reexamination of the resources directed toward sleep quality in this population.
Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Interventions aimed at improving sleep hygiene for college students are needed.
Major finding: Insomnia and other sleep disturbances are independent risk factors for poor academic performance, on par with binge drinking or marijuana use.
Data source: An analysis of 43,000 responses to the American College Health Association National College Health survey.
Disclosures: Dr. Prichard and Dr. Hartmann reported no conflicts. They received no outside funding for the study.
AMA: Obama needs to take immediate action on VA health care
CHICAGO – The American Medical Association’s policy-making body called on President Obama to take immediate action to increase access to care for the nation’s veterans by encouraging them to use physicians outside the Veterans Affairs system.
The House of Delegates also urged state medical societies to create registries of physicians willing and able to take veterans as patients.
The action comes as Congress moves to pass legislation to help alleviate delays in the VA system that have led to long wait times for appointments. The revelation that phony wait lists were created in an attempt to cover up the delays led to the resignation of VA Secretary Eric Shinseki on May 30.
The U.S. House of Representatives on June 10 unanimously passed a bill sponsored by Rep. Jeff Miller (R-Fla.) that would allow veterans to seek care outside the VA system. A similar bipartisan bill in the U.S. Senate that is sponsored by Sen. Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) may be voted on this week.
The proposal adopted by the AMA House of Delegates at its annual meeting was sponsored by delegations from Florida, Texas, New York, and California. In addition to asking President Obama to provide timely access to health care for veterans by allowing for, and paying for, care outside the VA system, it also calls on Congress to act rapidly on a long-term solution that will provide timely access to care. And, the resolution requested that the AMA issue a press release by June 12 that calls attention to its new policy on care for veterans.
Most of the delegates were in favor of the new policy.
Dr. David McKalip, a Florida neurosurgeon, said his delegation sought the policy because a solution was needed now. He said that he was already providing care to veterans, and that there was "an abundance of care" available outside the VA.
Others said they, too, were already treating veterans, either in emergency departments or in their offices. Dr. Mario Motta, a cardiologist and delegate from Massachusetts, said that he often treated veterans for acute problems and then would send them back to the VA for follow-up. But, they often end up back in his office when they can’t get in to see a cardiologist in the VA system, he said. "We need to fix this issue," said Dr. Motta.
Some delegates said that the AMA should not be trying to fix what is essentially a VA problem.
Dr. Richard Evans, a general surgeon from Dover-Foxcroft, Maine, and a veteran, said that he, too, treated many veterans. But he said that it seemed like the AMA was merely trying to take advantage of a hot topic. "I’m certain everyone in this room is supportive of veterans’ care," said Dr. Evans. But, he added, "I see no need for this resolution."
Another physician-veteran, Dr. Thomas G. Peters, an alternate delegate from Florida, said that all physicians should be willing to see veterans. But, said the Jacksonville-based transplant surgeon, "the responsibility to fix the VA should be with the VA."
The American Academy of Family Physicians also recently urged the President to enlist physicians in the community to help alleviate the backlog at the VA.
In a June 4 letter, Dr. Jeff Cain, AAFP board chair, also said the group was recommending that civilian physicians be allowed to order diagnostic tests at VA facilities, and refer to specialists at those facilities, and to allow prescriptions written by civilian physicians to be filled at VA pharmacies.
"While these policy recommendations are not a solution to all the challenges facing the VA health system, they do represent an opportunity to alleviate the current backlog and facilitate access to primary care services for thousands of veterans," Dr. Cain said in the letter.
On Twitter @aliciaault
CHICAGO – The American Medical Association’s policy-making body called on President Obama to take immediate action to increase access to care for the nation’s veterans by encouraging them to use physicians outside the Veterans Affairs system.
The House of Delegates also urged state medical societies to create registries of physicians willing and able to take veterans as patients.
The action comes as Congress moves to pass legislation to help alleviate delays in the VA system that have led to long wait times for appointments. The revelation that phony wait lists were created in an attempt to cover up the delays led to the resignation of VA Secretary Eric Shinseki on May 30.
The U.S. House of Representatives on June 10 unanimously passed a bill sponsored by Rep. Jeff Miller (R-Fla.) that would allow veterans to seek care outside the VA system. A similar bipartisan bill in the U.S. Senate that is sponsored by Sen. Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) may be voted on this week.
The proposal adopted by the AMA House of Delegates at its annual meeting was sponsored by delegations from Florida, Texas, New York, and California. In addition to asking President Obama to provide timely access to health care for veterans by allowing for, and paying for, care outside the VA system, it also calls on Congress to act rapidly on a long-term solution that will provide timely access to care. And, the resolution requested that the AMA issue a press release by June 12 that calls attention to its new policy on care for veterans.
Most of the delegates were in favor of the new policy.
Dr. David McKalip, a Florida neurosurgeon, said his delegation sought the policy because a solution was needed now. He said that he was already providing care to veterans, and that there was "an abundance of care" available outside the VA.
Others said they, too, were already treating veterans, either in emergency departments or in their offices. Dr. Mario Motta, a cardiologist and delegate from Massachusetts, said that he often treated veterans for acute problems and then would send them back to the VA for follow-up. But, they often end up back in his office when they can’t get in to see a cardiologist in the VA system, he said. "We need to fix this issue," said Dr. Motta.
Some delegates said that the AMA should not be trying to fix what is essentially a VA problem.
Dr. Richard Evans, a general surgeon from Dover-Foxcroft, Maine, and a veteran, said that he, too, treated many veterans. But he said that it seemed like the AMA was merely trying to take advantage of a hot topic. "I’m certain everyone in this room is supportive of veterans’ care," said Dr. Evans. But, he added, "I see no need for this resolution."
Another physician-veteran, Dr. Thomas G. Peters, an alternate delegate from Florida, said that all physicians should be willing to see veterans. But, said the Jacksonville-based transplant surgeon, "the responsibility to fix the VA should be with the VA."
The American Academy of Family Physicians also recently urged the President to enlist physicians in the community to help alleviate the backlog at the VA.
In a June 4 letter, Dr. Jeff Cain, AAFP board chair, also said the group was recommending that civilian physicians be allowed to order diagnostic tests at VA facilities, and refer to specialists at those facilities, and to allow prescriptions written by civilian physicians to be filled at VA pharmacies.
"While these policy recommendations are not a solution to all the challenges facing the VA health system, they do represent an opportunity to alleviate the current backlog and facilitate access to primary care services for thousands of veterans," Dr. Cain said in the letter.
On Twitter @aliciaault
CHICAGO – The American Medical Association’s policy-making body called on President Obama to take immediate action to increase access to care for the nation’s veterans by encouraging them to use physicians outside the Veterans Affairs system.
The House of Delegates also urged state medical societies to create registries of physicians willing and able to take veterans as patients.
The action comes as Congress moves to pass legislation to help alleviate delays in the VA system that have led to long wait times for appointments. The revelation that phony wait lists were created in an attempt to cover up the delays led to the resignation of VA Secretary Eric Shinseki on May 30.
The U.S. House of Representatives on June 10 unanimously passed a bill sponsored by Rep. Jeff Miller (R-Fla.) that would allow veterans to seek care outside the VA system. A similar bipartisan bill in the U.S. Senate that is sponsored by Sen. Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) may be voted on this week.
The proposal adopted by the AMA House of Delegates at its annual meeting was sponsored by delegations from Florida, Texas, New York, and California. In addition to asking President Obama to provide timely access to health care for veterans by allowing for, and paying for, care outside the VA system, it also calls on Congress to act rapidly on a long-term solution that will provide timely access to care. And, the resolution requested that the AMA issue a press release by June 12 that calls attention to its new policy on care for veterans.
Most of the delegates were in favor of the new policy.
Dr. David McKalip, a Florida neurosurgeon, said his delegation sought the policy because a solution was needed now. He said that he was already providing care to veterans, and that there was "an abundance of care" available outside the VA.
Others said they, too, were already treating veterans, either in emergency departments or in their offices. Dr. Mario Motta, a cardiologist and delegate from Massachusetts, said that he often treated veterans for acute problems and then would send them back to the VA for follow-up. But, they often end up back in his office when they can’t get in to see a cardiologist in the VA system, he said. "We need to fix this issue," said Dr. Motta.
Some delegates said that the AMA should not be trying to fix what is essentially a VA problem.
Dr. Richard Evans, a general surgeon from Dover-Foxcroft, Maine, and a veteran, said that he, too, treated many veterans. But he said that it seemed like the AMA was merely trying to take advantage of a hot topic. "I’m certain everyone in this room is supportive of veterans’ care," said Dr. Evans. But, he added, "I see no need for this resolution."
Another physician-veteran, Dr. Thomas G. Peters, an alternate delegate from Florida, said that all physicians should be willing to see veterans. But, said the Jacksonville-based transplant surgeon, "the responsibility to fix the VA should be with the VA."
The American Academy of Family Physicians also recently urged the President to enlist physicians in the community to help alleviate the backlog at the VA.
In a June 4 letter, Dr. Jeff Cain, AAFP board chair, also said the group was recommending that civilian physicians be allowed to order diagnostic tests at VA facilities, and refer to specialists at those facilities, and to allow prescriptions written by civilian physicians to be filled at VA pharmacies.
"While these policy recommendations are not a solution to all the challenges facing the VA health system, they do represent an opportunity to alleviate the current backlog and facilitate access to primary care services for thousands of veterans," Dr. Cain said in the letter.
On Twitter @aliciaault
AT THE AMA HOD MEETING
AMA calls for background checks for all gun purchases
CHICAGO – The American Medical Association said it will back legislation to require criminal background checks for all gun sales, whether they are public or private.
The House of Delegates voted at its annual meeting to approve the new policy position as a public health issue. The debate and vote took place June 10, the same day as an Oregon school shooting where a high school student and the shooter died.
The resolution to support background checks was brought forward by the Illinois delegation to the House.
Dr. Maryanne C. Bombaugh, an alternate delegate with the Massachusetts Medical Society, introduced an amendment to extend background checks to all gun transfers, as well.
Dr. Bombaugh, an ob.gyn. in Falmouth, Mass., said that adding transfers would help close many loopholes that private sellers use to skirt background checks.
But some delegates said that might be impossible to enforce, and might interfere with transfers among family members. Louisiana delegate Dr. Vincent Culotta said that he had been given a gun by his father to use for hunting when he was younger, and that he did not think that type of transfer should be subject to a background check.
Another delegate, a psychiatrist, said that background checks on transfers could potentially stop family members from taking possession of guns that relatives might use in suicide attempts.
But others said they supported more scrutiny of transfers. One delegate said it might prevent one person from buying a gun for someone else who could not pass a background check.
Another suggested that requiring checks on transfers – even for family members – made sense, just as transferring ownership of a vehicle required a check that the recipient possessed a driver’s license.
On Twitter @aliciaault
CHICAGO – The American Medical Association said it will back legislation to require criminal background checks for all gun sales, whether they are public or private.
The House of Delegates voted at its annual meeting to approve the new policy position as a public health issue. The debate and vote took place June 10, the same day as an Oregon school shooting where a high school student and the shooter died.
The resolution to support background checks was brought forward by the Illinois delegation to the House.
Dr. Maryanne C. Bombaugh, an alternate delegate with the Massachusetts Medical Society, introduced an amendment to extend background checks to all gun transfers, as well.
Dr. Bombaugh, an ob.gyn. in Falmouth, Mass., said that adding transfers would help close many loopholes that private sellers use to skirt background checks.
But some delegates said that might be impossible to enforce, and might interfere with transfers among family members. Louisiana delegate Dr. Vincent Culotta said that he had been given a gun by his father to use for hunting when he was younger, and that he did not think that type of transfer should be subject to a background check.
Another delegate, a psychiatrist, said that background checks on transfers could potentially stop family members from taking possession of guns that relatives might use in suicide attempts.
But others said they supported more scrutiny of transfers. One delegate said it might prevent one person from buying a gun for someone else who could not pass a background check.
Another suggested that requiring checks on transfers – even for family members – made sense, just as transferring ownership of a vehicle required a check that the recipient possessed a driver’s license.
On Twitter @aliciaault
CHICAGO – The American Medical Association said it will back legislation to require criminal background checks for all gun sales, whether they are public or private.
The House of Delegates voted at its annual meeting to approve the new policy position as a public health issue. The debate and vote took place June 10, the same day as an Oregon school shooting where a high school student and the shooter died.
The resolution to support background checks was brought forward by the Illinois delegation to the House.
Dr. Maryanne C. Bombaugh, an alternate delegate with the Massachusetts Medical Society, introduced an amendment to extend background checks to all gun transfers, as well.
Dr. Bombaugh, an ob.gyn. in Falmouth, Mass., said that adding transfers would help close many loopholes that private sellers use to skirt background checks.
But some delegates said that might be impossible to enforce, and might interfere with transfers among family members. Louisiana delegate Dr. Vincent Culotta said that he had been given a gun by his father to use for hunting when he was younger, and that he did not think that type of transfer should be subject to a background check.
Another delegate, a psychiatrist, said that background checks on transfers could potentially stop family members from taking possession of guns that relatives might use in suicide attempts.
But others said they supported more scrutiny of transfers. One delegate said it might prevent one person from buying a gun for someone else who could not pass a background check.
Another suggested that requiring checks on transfers – even for family members – made sense, just as transferring ownership of a vehicle required a check that the recipient possessed a driver’s license.
On Twitter @aliciaault
AT THE AMA HOD MEETING
Advocates, House members press for involuntary treatment
WASHINGTON – People with serious mental illness need more attention, including involuntary treatment, advocates said at a hearing to push a wide-ranging bill that addresses issues around the hardest-to-reach patients.
The bill, H.R. 3717, was introduced in December by Rep. Tim Murphy, (R-Penn.), a clinical psychologist and chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee.
Rep. Murphy said people with serious and persistent mental illness – including severe bipolar disorder and schizophrenia – are not being well served.
An almost-2-year investigation by the subcommittee "reveals that the current mental health system does not respond until after a crisis has already occurred because we do not empower parents, patients, clinicians, and law enforcement to stop it from happening," he said at the hearing.
He cited a recent list of those with severe mental illness who had undertreated or untreated disease, including Elliot Rodger, who killed 6 people and himself in Isla Vista, Calif.; Adam Lanza, who, in 2012, killed 20 children, 6 adults, his mother, and himself in Newtown, Conn.; and Aaron Alexis, who went on a shooting spree in September 2013 at the Navy Yard in Washington and killed 12 people, then killed himself.
Treatment might help prevent violent episodes, Rep. Murphy said. In the subcommittee report, Rep. Murphy and his staff noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, 40% of adults with serious mental illness reported not receiving any treatment. It takes an average of 110 weeks between the onset of symptoms and an individual’s entering into treatment, according to the letter.
Rep. Murphy’s bill – the Helping Families in Mental Health Crisis Act – seeks to create a new infrastructure to focus on serious mental illness. It also takes issue with how SAMHSA is being administered and how it decides on grantees.
A new assistant secretary for mental health and substance use disorders would oversee the SAMHSA administrator, and establish a National Mental Health Policy Laboratory to more closely supervise SAMHSA grantees and make sure that they undertook evidence-based projects. New telepsychiatry and primary care physician training grants would be provided to states to promote the use of telehealth. The bill would allow caregivers to get access to protected health information, when the patient’s provider reasonably believes it is necessary for that information to be made available to protect the individual’s health, safety, or welfare or the safety of one or more other individuals – even it the patient has not consented to disclosure.
After the bill was introduced last year, the American Psychiatric Association wrote a letter to Rep. Murphy praising the comprehensive nature of the package and its emphasis on providing evidence-based services.
At the hearing, Edward F. Kelly III, the father of an adult son with schizophrenia, said HIPAA had prevented him and his wife from getting information on their son’s treatment, hospitalizations, releases, encounters with the legal system, and whereabouts.
He chided organizations that he said were advocating against involuntary treatment of people with severe mental illness. Mr. Kelly urged Congress to support Rep. Murphy’s bill.
"Don’t fear the threats of unconstitutionality. Don’t fear the threats of lawsuits," he said.
Mr. Kelly urged Congress to support assisted outpatient treatment, known as AOT. D.J. Jaffe, founder of Mental Illness Policy Org., said that AOT – which allows courts to order patients into outpatient treatment in the community – reduces violence, incarceration, and homelessness. Many of those with severe mental illness are not aware that they need help, he said. "They are never going to volunteer for treatment," Mr. Jaffe said. "We have to recognize this reality."
AOT is "an off-ramp before jail," he said. "It’s like putting a fence at the edge of the cliff, rather than an ambulance at the bottom."
Rep. Murphy’s bill has 87 cosponsors. There is no companion bill in the Senate.
On Twitter @aliciaault
WASHINGTON – People with serious mental illness need more attention, including involuntary treatment, advocates said at a hearing to push a wide-ranging bill that addresses issues around the hardest-to-reach patients.
The bill, H.R. 3717, was introduced in December by Rep. Tim Murphy, (R-Penn.), a clinical psychologist and chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee.
Rep. Murphy said people with serious and persistent mental illness – including severe bipolar disorder and schizophrenia – are not being well served.
An almost-2-year investigation by the subcommittee "reveals that the current mental health system does not respond until after a crisis has already occurred because we do not empower parents, patients, clinicians, and law enforcement to stop it from happening," he said at the hearing.
He cited a recent list of those with severe mental illness who had undertreated or untreated disease, including Elliot Rodger, who killed 6 people and himself in Isla Vista, Calif.; Adam Lanza, who, in 2012, killed 20 children, 6 adults, his mother, and himself in Newtown, Conn.; and Aaron Alexis, who went on a shooting spree in September 2013 at the Navy Yard in Washington and killed 12 people, then killed himself.
Treatment might help prevent violent episodes, Rep. Murphy said. In the subcommittee report, Rep. Murphy and his staff noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, 40% of adults with serious mental illness reported not receiving any treatment. It takes an average of 110 weeks between the onset of symptoms and an individual’s entering into treatment, according to the letter.
Rep. Murphy’s bill – the Helping Families in Mental Health Crisis Act – seeks to create a new infrastructure to focus on serious mental illness. It also takes issue with how SAMHSA is being administered and how it decides on grantees.
A new assistant secretary for mental health and substance use disorders would oversee the SAMHSA administrator, and establish a National Mental Health Policy Laboratory to more closely supervise SAMHSA grantees and make sure that they undertook evidence-based projects. New telepsychiatry and primary care physician training grants would be provided to states to promote the use of telehealth. The bill would allow caregivers to get access to protected health information, when the patient’s provider reasonably believes it is necessary for that information to be made available to protect the individual’s health, safety, or welfare or the safety of one or more other individuals – even it the patient has not consented to disclosure.
After the bill was introduced last year, the American Psychiatric Association wrote a letter to Rep. Murphy praising the comprehensive nature of the package and its emphasis on providing evidence-based services.
At the hearing, Edward F. Kelly III, the father of an adult son with schizophrenia, said HIPAA had prevented him and his wife from getting information on their son’s treatment, hospitalizations, releases, encounters with the legal system, and whereabouts.
He chided organizations that he said were advocating against involuntary treatment of people with severe mental illness. Mr. Kelly urged Congress to support Rep. Murphy’s bill.
"Don’t fear the threats of unconstitutionality. Don’t fear the threats of lawsuits," he said.
Mr. Kelly urged Congress to support assisted outpatient treatment, known as AOT. D.J. Jaffe, founder of Mental Illness Policy Org., said that AOT – which allows courts to order patients into outpatient treatment in the community – reduces violence, incarceration, and homelessness. Many of those with severe mental illness are not aware that they need help, he said. "They are never going to volunteer for treatment," Mr. Jaffe said. "We have to recognize this reality."
AOT is "an off-ramp before jail," he said. "It’s like putting a fence at the edge of the cliff, rather than an ambulance at the bottom."
Rep. Murphy’s bill has 87 cosponsors. There is no companion bill in the Senate.
On Twitter @aliciaault
WASHINGTON – People with serious mental illness need more attention, including involuntary treatment, advocates said at a hearing to push a wide-ranging bill that addresses issues around the hardest-to-reach patients.
The bill, H.R. 3717, was introduced in December by Rep. Tim Murphy, (R-Penn.), a clinical psychologist and chairman of the Oversight and Investigations Subcommittee of the Energy & Commerce Committee.
Rep. Murphy said people with serious and persistent mental illness – including severe bipolar disorder and schizophrenia – are not being well served.
An almost-2-year investigation by the subcommittee "reveals that the current mental health system does not respond until after a crisis has already occurred because we do not empower parents, patients, clinicians, and law enforcement to stop it from happening," he said at the hearing.
He cited a recent list of those with severe mental illness who had undertreated or untreated disease, including Elliot Rodger, who killed 6 people and himself in Isla Vista, Calif.; Adam Lanza, who, in 2012, killed 20 children, 6 adults, his mother, and himself in Newtown, Conn.; and Aaron Alexis, who went on a shooting spree in September 2013 at the Navy Yard in Washington and killed 12 people, then killed himself.
Treatment might help prevent violent episodes, Rep. Murphy said. In the subcommittee report, Rep. Murphy and his staff noted that the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that in 2009, 40% of adults with serious mental illness reported not receiving any treatment. It takes an average of 110 weeks between the onset of symptoms and an individual’s entering into treatment, according to the letter.
Rep. Murphy’s bill – the Helping Families in Mental Health Crisis Act – seeks to create a new infrastructure to focus on serious mental illness. It also takes issue with how SAMHSA is being administered and how it decides on grantees.
A new assistant secretary for mental health and substance use disorders would oversee the SAMHSA administrator, and establish a National Mental Health Policy Laboratory to more closely supervise SAMHSA grantees and make sure that they undertook evidence-based projects. New telepsychiatry and primary care physician training grants would be provided to states to promote the use of telehealth. The bill would allow caregivers to get access to protected health information, when the patient’s provider reasonably believes it is necessary for that information to be made available to protect the individual’s health, safety, or welfare or the safety of one or more other individuals – even it the patient has not consented to disclosure.
After the bill was introduced last year, the American Psychiatric Association wrote a letter to Rep. Murphy praising the comprehensive nature of the package and its emphasis on providing evidence-based services.
At the hearing, Edward F. Kelly III, the father of an adult son with schizophrenia, said HIPAA had prevented him and his wife from getting information on their son’s treatment, hospitalizations, releases, encounters with the legal system, and whereabouts.
He chided organizations that he said were advocating against involuntary treatment of people with severe mental illness. Mr. Kelly urged Congress to support Rep. Murphy’s bill.
"Don’t fear the threats of unconstitutionality. Don’t fear the threats of lawsuits," he said.
Mr. Kelly urged Congress to support assisted outpatient treatment, known as AOT. D.J. Jaffe, founder of Mental Illness Policy Org., said that AOT – which allows courts to order patients into outpatient treatment in the community – reduces violence, incarceration, and homelessness. Many of those with severe mental illness are not aware that they need help, he said. "They are never going to volunteer for treatment," Mr. Jaffe said. "We have to recognize this reality."
AOT is "an off-ramp before jail," he said. "It’s like putting a fence at the edge of the cliff, rather than an ambulance at the bottom."
Rep. Murphy’s bill has 87 cosponsors. There is no companion bill in the Senate.
On Twitter @aliciaault
EXPERT ANALYSIS AT AN ENERGY & COMMERCE SUBCOMMITTEE HEARING
Teens who sleep less at risk for greater insulin resistance
MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.
That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.
There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.
There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.
Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.
Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.
She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.
The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.
The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.
There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.
There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).
Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.
"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.
She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.
Dr. Koren and her colleagues hope to replicate the study in a larger cohort.
Dr. Koren reported no relevant financial conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.
That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.
There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.
There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.
Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.
Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.
She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.
The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.
The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.
There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.
There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).
Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.
"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.
She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.
Dr. Koren and her colleagues hope to replicate the study in a larger cohort.
Dr. Koren reported no relevant financial conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Teens who do not sleep enough may be at risk for gaining weight and increased insulin resistance.
That’s the conclusion of a small pilot study conducted by Dr. Dorit Koren and her colleagues at the University of Chicago.
There is already considerable epidemiologic data that lack of sleep is a risk factor for obesity in children and young adults, said Dr. Koren who is with the departments of pediatrics and medicine in the pediatric endocrinology department at the University of Chicago.
There have been studies examining the risk of type 2 diabetes with sleep deprivation in adults, but there has been no population-based data in children examining the risk of type 2 diabetes in children and adolescents – and that’s important because they are not just small adults, she said.
Adolescents tend to be more insulin resistant because of the pubertal growth spurt, and they have a different sleep architecture than do adults, as they tend to be late to bed and late to rise, said Dr. Koren.
Previous studies looking at glucose homeostasis in adolescents have mostly looked at fasting rather than dynamic measures of glucose homeostasis and that is a limitation because fasting measures reflect primarily hepatic insulin sensitivity, she said. Most studies also were conducted in a sleep lab, which is not a natural environment.
She and her colleagues wanted to study adolescents at home and also gauge postprandial glucose metabolism. They enrolled 10 adolescents, aged 13-18 years. A total of 70% were black and 30% were non-Hispanic white. Just under half were male. They were mostly overweight, as measured by body mass index, although some were very lean, and some were very obese, said Dr. Koren.
The patients were first given an overnight polysomnogram, and then told to measure sleep at home through an actigraphy device, and sleep diaries. The actigraphy helped back up the diaries, which are known to be "remarkably inaccurate" among adolescents, said Dr. Koren. They kept track of their sleep for 2 weeks.
The teens then returned for a second visit to the clinic. The researchers analyzed the average bedtime and waking time, and then asked them to restrict their sleep by going to bed an hour later. After returning again, the new measures after sleep restriction were compared with the earlier measures.
There was a strong correlation between weight and sleep duration, with longer sleep associated with less weight. They also saw a trend toward a greater waist circumference in adolescents who slept less.
There was a significant negative association between sleep duration and the 90-minute oral glucose tolerance test, with a P = .036. Restricted sleep also led to greater insulin resistance as measured by the homeostasis model assessment of insulin resistance (P = .091), and the whole-body insulin sensitivity index (P = .091).
Dr. Koren and her colleagues also performed linear regression analyses, controlling for either waist circumference or weight. Sleep deprivation was still the most significant factor as measured on the 90-minute glucose tolerance test and by the whole-body insulin sensitivity index.
"The model suggests that these relationships between home sleep deprivation and insulin resistance or hyperglycemia are independent of obesity, generalized or central," said Dr. Koren.
She cited the example of a 15-year-old female subject, who was lean. Her sleep went from 8.7 hours at baseline to 7.9 hours with the restriction. Her glucose values did not change significantly between baseline and restriction, but her insulin levels were noticeably higher in the sleep-restricted state, said Dr. Koren. Those levels rose an hour into the 90-minute tolerance test, which suggests that she was insulin resistant and needed to secrete more insulin to maintain glycemia.
Dr. Koren and her colleagues hope to replicate the study in a larger cohort.
Dr. Koren reported no relevant financial conflicts.
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Sleep restriction can lead to obesity and insulin resistance.
Major finding: Teens who underslept by an hour a night were more likely to be heavier, have a larger weight circumference, and to have greater insulin resistance.
Data source: A 10-patient pilot study of home sleep.
Disclosures: The study was supported by a National Institutes of Health grant. Dr. Koren reported no conflicts.
Sleep society: Screen for apnea at first Medicare visit
MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.
Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.
An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.
The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.
"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.
Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.
The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.
The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.
The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.
Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.
On Twitter @aliciaault
MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.
Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.
An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.
The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.
"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.
Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.
The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.
The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.
The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.
Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.
On Twitter @aliciaault
MINNEAPOLIS – The American Academy of Sleep Medicine is pushing to have a simple sleep apnea questionnaire included in the initial Welcome to Medicare preventive care visit.
Including such a screening tool would help identify obstructive sleep apnea (OSA) when patients first join the Medicare program and thus improve the odds of diagnosing and treating the condition, said Dr. Timothy Morgenthaler, president of the AASM. Getting a handle on OSA could also reduce the potential that the beneficiary will develop related chronic conditions, and that will help Medicare curb expenditures, he said.
An estimated 20% of current Medicare beneficiaries have OSA. That number is expected to grow with the rising obesity rates, he said. Untreated OSA can increase the risk of hypertension, heart disease, type 2 diabetes, and stroke, said Dr. Morgenthaler, who is professor of medicine at the Mayo Clinic in Rochester, Minn.
The AASM has been lobbying Congress to include a validated OSA screen in the initial Medicare visit and found sponsors in Rep. Michael Burgess (R-Tex.) and Rep. Bobby Rush (D-Ill.). The two congressmen introduced a bill (H.R. 4695) that would do just that on May 21.
"This important legislation addresses the barriers that prevent new Medicare beneficiaries from receiving what we know to be required sleep apnea services," Dr. Morgenthaler said at the annual meeting of the Associated Professional Sleep Societies.
Rep. Erik Paulsen (R-Minn.), who recently signed on to the bill as a cosponsor, told AASM attendees that adding an OSA screen to the initial Medicare visit would help increase detection of disease, raise patient awareness, and "improve health care quality and reduce costs to the Medicare program," over the long term.
The AASM is asking its members to back the legislation and educate local lawmakers and patients through the group’s Seniors Sleep Campaign.
The association also wants to make it easier for board-certified sleep medicine specialists to care for Medicare patients from start to finish. Currently, antikickback laws prevent sleep specialists and sleep centers from directly providing therapeutic durable medical equipment to Medicare patients, said Dr. Morgenthaler.
The AASM has developed model language for an exception to that statute, which it hopes legislators or regulators will approve, he said. It would allow board-certified specialists to provide the continuum of care from start to finish, including durable medical equipment such as continuous positive airway pressure devices.
Eliminating the current fragmented system of care would eliminate waste, simplify the work flow, and improve the quality of care and reduce costs, said Dr. Morgenthaler.
On Twitter @aliciaault
AT SLEEP 2014
Suicide more likely after midnight
MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.
Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "
Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.
He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.
They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.
They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.
A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.
The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.
At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.
"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)
It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.
As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."
Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."
Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.
The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.
Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "
Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.
He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.
They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.
They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.
A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.
The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.
At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.
"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)
It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.
As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."
Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."
Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.
The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
On Twitter @aliciaault
MINNEAPOLIS – Suicide may be more likely after midnight and in particular between 2 a.m. and 3 a.m., according to new research.
"This appears to be the first data to suggest that circadian factors may contribute to suicidality, and help explain why insomnia is also a risk factor for suicidal ideation and behavior," said Michael L. Perlis, Ph.D., of the department of psychiatry and director of the Penn behavioral sleep medicine program at the University of Pennsylvania, Philadelphia.
Dr. Perlis said that it has long been known that insomnia may lead to a certain despair; he found a reference to it in the Lancet in 1914. The anecdotal report said, "The rector of a parish having written the following letter, was found dead in a pool with a bullet wound in the head: ‘Another sleepless night; no real sleep for weeks. Oh, my poor brain, I cannot bear the lengthy, dark hours of the night.’ "
Previous studies have shown that completed suicides rise starting in the morning, and then peak in the afternoon, with trends being lowest from midnight to 4 a.m., Dr. Perlis said at the annual meeting of the Associated Professional Sleep Societies.
He and his colleagues at Penn and the Philadelphia Veteran Affairs Medical Center, also in Philadelphia, decided to take a different look at the data – instead of arraying completed suicides as a percent per hour, they examined the odds of completed suicide by clock hour, accounting for the proportion of the population awake at each hour.
They hypothesized that people with insomnia may be at higher risk for suicidal ideation and behavior because of their chaotic and dysfunctional thoughts and nightmares, in which small problems appear much larger. Further, people who are depressed and suicidal also have higher rates of insomnia.
They looked at 35,332 suicides reported to the National Violent Death Reporting System at the Centers for Disease Control and Prevention. The data come from 18 states and was compiled from 2002 to 2010. The reports included the time of the fatal injury.
A total of 81% (28,704) of the suicides were in men and 84% (29,771) were in non-Hispanic whites. Suicide was highest among 35-44-year-olds and 45-54-year-olds, at about 20% for each age group.
The researchers used existing data on the number of Americans awake at any given hour and plotted the suicides by 1-hour increments.
At 7 a.m., the mean suicide rate was just under 2%. But at midnight, it was 8.3%; at 2 a.m., it was 16%, and at 3 a.m. it was 15%. Rates continued to drop from there, to a little over 2% at 6 a.m.
"Frankly, it makes all the sense in the world that completed suicides would occur more frequently at night," Dr. Perlis said in an interview. At that time, there is an absence of social constraints and social supports, a despair that comes from sleeplessness and easier access to alcohol, substances, and weapons, he said. Impulse control also may be lower (Sleep 2014;vol.237:abstract supplement,abst. 0768)
It is also "likely that being awake at night, when one is biologically prepared to be asleep, may be a risk factor in and of itself," Dr. Perlis said.
As far as why suicides peaked between 2 a.m. and 3 a.m. in their study, Dr. Perlis said that it may be that it’s the time of day "where the pressure to sleep is greatest and as a result this is the time when executive function is most impaired."
Dr. Perlis said that the study, "suggests that interventions for insomnia and nightmares may serve to reduce the risk for completed suicide and likely will also reduce suicidal ideation and behavior."
Short term interventions can include medications and other medical strategies. But Dr. Perlis recommends cognitive-behavioral therapy that targets insomnia and nightmares for longer-term treatment. The Philadelphia Veterans Affairs began system-wide training in CBT for insomnia and nightmares 4 years ago, he said.
The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
On Twitter @aliciaault
FROM SLEEP 2014
Key clinical point: Nighttime wakefulness is a risk factor for suicide.
Major finding: Suicides rose after midnight, peaking at a mean 16% at 2 a.m.
Data source: The authors analyzed surveillance data on 35,332 completed suicides from the CDC’s National Violent Death Reporting System.
Disclosures: The research was supported by the University of Pennsylvania and the National Institutes of Health. Dr. Perlis and his colleagues reported no conflicts.
